Food Diary of a Pregnant Dietitian

A lot of people have asked me if my eating habits have changed since becoming pregnant.  In general, I'd say they're relatively the same, but I'm certainly hungrier for more food than I used to be!

The whole "eating for two" statement is really a fallacy.  Starting in the second trimester and in addition to greater vitamin/mineral requirements, pregnant women need only 300 extra calories per day to support a growing fetus.  That equates to half a sandwich, an apple with 2 T peanut butter, or a large cookie.  Some of these extra calories should contain protein, since protein needs are also increased.

Does this mean I count out 300 calories and make sure to scarf them down?  Nope.  I don't count calories at all, just like before I was pregnant.  I just listen to my body and monitor my weight gain with my doc to make sure I'm getting enough.  My activity levels have decreased a bit since pre-pregnancy and some days the baby seems to be growing more rapidly than others, so it's really hard - and not necessary - to focus on numbers while eating.  I am aware of my hunger and fullness and make sure to have plenty of snacks nearby for when hunger strikes.  Some days I'm ravenous, while other days it seems like there's just not quite enough room in my abdomen to fit much food (which may be true).

By the way, recommended pregnancy weight gain ranges from 25-35 lb.  I will likely gain around 30ish pounds if I gain at the same rate I'm going, but I absolutely don't obsess about it.  Pre-pregnancy I rarely weighed myself, but now I hop on once a week to make sure I'm gaining enough and to check that I haven't gained a really big amount - such as 5 pounds in a week - because that can indicate that the body is retaining too much fluid and preeclampsia may be setting in.

Generally, physicians want pregnant women want to gain 2-5 pounds in the first trimester and about a pound a week thereafter. That doesn't mean that every person will follow this pattern.  I gained 6 pounds in the first trimester and then stayed there for about 4 weeks despite having an increased appetite.  After that, my weight gain pretty much increased by 0.5 - 1.5 lb per week.

What if you gain more in pregnancy?  While there are some potential risks to you and your baby if you gain a significant amount of weight, what I usually advise clients to do is listen to their bodies and not just eat "because they can."  In fact, if you have an intuitive eating mindset, you always "can" eat anything; pregnancy is no different.  Nutrition is perhaps the most critical during this imperative developmental stage, so focusing on nutrient dense foods and hunger/fullness - not necessarily weight gain - is the most important thing.  Some women will just naturally gain more or less weight than is recommended, and as long as your doctor is OK with it then don't stress.

I wanted to share three days of eating with you all so you could check out what it's really like to be a dietitian while pregnant.  I absolutely like sweets and comfort foods just like the rest of us, and I honor my cravings and only eat foods I really like.  As you will see, I still eat a lot of veggies and fruits while making sure to get protein, fat, and fiber in the form of whole grains and beans.  For more info on the supplements I'm taking, check out this post on first trimester nutrition or this post about pre-conception nutrition.  The prenatal vitamin I'm taking is divided into 3 doses per day to spread out the nutrients and not provide so much iron to the system at one time.  I take one with each meal.

For the record, my major pregnancy cravings have been the following:

- Chocolate - any kind, must have some daily

- Salads

- Turkey burgers from Red Robin

- Asian food

- Avocados

- Beans (any kind)

- Any sort of egg (although I make sure they're fully cooked)

Aversions (mainly during first trimester):

- Mushrooms

- Onions

- Peanut sauce on Picazzo's baked chicken wings (my sister and I used to get these all the time, but no more)

- Frozen yogurt (bad experience)

Note: I drink 2-3 cups of herbal ginger tea and 10-12 cups of water each day.  I don't necessarily eat everything on my plate; it just depends on how hungry I am.  When my body says it is full, I stop.

Day 1:

I was really hungry today!  Thank goodness I brought plenty of snacks to work. 

6 am - 45 minute walk with dogs

7 am - Breakfast

Ezekiel English muffin with almond butter topped with sliced banana

Prenatal vitamin, fish oil, probiotic, B complex, and Dr. Ben Kim's Greens

10 am - Snack

Tangerine chickpea and kale salad and an orange

2 calcium/magnesium/zinc + vitamin D (500 mg calcium total)

12 pm - Lunch

Romaine salad with tomatoes and avocado

Figg brand split pea soup topped with crumbled feta

Piece of dark chocolate

Prenatal vitamin

2:15 pm - Snack

Lara bar

2 calcium/magnesium/zinc + vitamin D

4:00 pm - Snack

Brussel sprout and beet salad

5:45 pm - few bites of chicken

6:00 pm - Karve class

7:15 pm - Dinner

Pomegranate chicken on top of quinoa

Salad made with romaine, apples, avocado, feta and homemade vinaigrette

1/2 piece of homemade GF bread with pasture butter

2 Hail Merry macaroons

1 Prenatal vitamin

Day 2:

Officially 27 weeks today!

6 am - 45 minute walk with dogs

7 am - Breakfast

Ezekiel English muffin topped with avocado, sliced tomato and 2 organic eggs cooked in pasture butter

Prenatal vitamin, fish oil, probiotic, B complex, and Dr. Ben Kim's Greens

10 am - Snack

Organic string cheese stick and a pear

12 pm - Lunch

Picazzo's Organic Italian Kitchen! Gluten-free slice of the day (pesto with ricotta and organic Italian sausage dipped in marinara sauce) and Berry Licious Salad (spinach, strawberries, feta cheese, walnuts, orange segments)

1 Dove dark chocolate Promise

Prenatal vitamin

2:30 pm - Snack

Lara bar

4:00 pm - Snack

Baby carrots dipped in garlic hummus

7:00 pm - Dinner

Cheesecake Factory!  Greg and I ordered off the "Skinny" menu because he's going for lighter fare these days

1/2 piece of "brown" bread with butter

1 Vietnamese Shrimp Summer Roll dipped in sauce (cold, wrapped in rice paper)

1 Mexican Chicken Lettuce Wrap

1/4 Skinny Turkey Burger and a few bites of side salad (ordered with regular vinaigrette instead of "Skinny")

Prenatal vitamin

Day 3:

OB appointment today with the lovely glucose drink (test for gestational diabetes):

6:00 am - 40 minute walk with dogs

7:00 am - Breakfast - had to be low-carb prior to test!

3 pasture eggs cooked in 1 tsp. pasture butter

1/4 avocado, sliced

4 slices tomato

Sprinkles of feta cheese 

Prenatal vitamin, fish oil, probiotic, B complex

7:20 am - Yummy (terrible) "Fruit Punch" glucose drink

9:00 am - Decaf latte from Starbucks (2% milk, added stevia and cinnamon)

11:30 am - Lunch

Salad with romaine, cucumber, avocado and hummus

Leftover chicken and a little quinoa

Piece of dark chocolate

Prenatal vitamin

2:30 pm - Snack

Lara bar

2 calcium/mag/zinc + vitamin D supplements

4:00 pm - Snack

Carrots and hummus

Organic string cheese

6:00 pm - Karve class

7:15 pm - Dinner

AJ's salmon, veggies and a few bites of mac & cheese (so heavy it hurt my tummy!)

Piece of healthy fudge 

Prenatal vitamin

So there you have it!  Each day I am for variety as much as possible, and I only eat foods I really love while getting in as much produce as possible.  I have been cooking less lately due to a very busy schedule, so there is less homemade food here than normal.  Sometimes I finish my plate, but most of the time my fullness tells me to stop.  That's the wonderful thing about our bodies - even when pregnant, we can listen to the signals our bodies give us to know when we have had enough.  And you know what?  If we really, really want something but we are full, we can save it for the next meal (or snack!).

*M*

Nutrition in the First Trimester

We are so excited to be expecting our first baby around January 22nd, 2013!  

It's amazing how quickly my pregnancy has gone already now that I'm almost 16 weeks, and yet when I think back to the first trimester, I remember how long the nausea-filled days seemed then.   I wanted to share how I coped through the first 3 months, having had learned a considerable amount through personal trial and error.  I wrote a more comprehensive post about preparing for pregnancy that talks about the importance of certain nutrients if you want to check out here.  (By the way, this was the most popular post of all time on my blog.  I think babies are on the brain for lots of people!)

First, I'll start with the supplements I'm taking.  The Prepping for Pregnancy post explain why each are so important:

3 Seroyal Pregna Vite (1 with each meal) - I also recommend Thorne Basic Prenatal and Innate Response Baby and Me Trimester I and II, but I personally tolerate Pregna Vite best

2 Nordic Naturals ProDHA Strawberry

1 Seroyal HMF Forte probiotic

2-4 Protocol Calcium/Magnesium/Vitamin D

Make it a point to look at the label of your prenatal vitamin.  Just because it's a prescription product or provided in a sample bag from your doc doesn't mean it is free of artificial dyes, hydrogenated oils, and other additives.  I recommend the products listed above because the are free from all of that yuckiness.

I am pretty vitamin D deficient again, despite having had bumped my serum levels to an optimal 57 ng/mL last year, so I also take some extra vitamin D a few times a week.

Let's review what you (unfortunately) should avoid during pregnancy:

- Deli meats, unless they're heated to 165 internally - they may be contaminated with the listeria bacterium, and pregnant women are 20 times more likely to contract it than others

- Imported soft cheeses and unpasteurized cheese - again, potential listeria risk; I eat soft cheese if I know it's pasteurized and made domestically (and most feta and goat cheese is)

- High mercury shellfish and raw fish - avoid shark, king mackerel, and tile fish, and unfortunately most sushi is out.  On the bright side, eel is considered lower in mercury, so I get cooked eel rolls when I go out for sushi.  Eat up to 12 ounces of low mercury fish per week, such as wild salmon and chunk light tuna.

- Alcohol - there's always some debate on this, but I would hate to wonder whether my drinking alcohol caused something down the road.  I have had a sip of really good wine just to get some of its flavor, but I doubt I'd ever have an entire drink until after the little one is born.  If I really want a drink at a bar, I get a mixed juice "mocktail."

- Artificial sweeteners - this one is my own recommendations, but I think it's extremely important.  Try to kick the diet soda habit, since your teeny, vulnerable baby is also receiving these chemicals.

- Caffeine - you can still do up to 200 mg, but I avoid it all together because it's a stimulant and diuretic.  (Yup, bummer.)

For more on what to avoid, check out this site by the American Pregnancy Association.

First trimester can be hard for women because they may experience nausea, vomiting, food aversions, and sensitivity to smell, all at a time where most people are still trying to not share the news of their pregnancy just yet.  Some don't have very many issues, while others require medical intervention just to get through the first stage of pregnancy.

I personally had a heck of a time with nausea and was pretty uncomfortable from weeks 5 through 13 or 14, but fortunately I could keep most food down.  I did become extremely particular about what I wanted to eat.  Imagine what you feel like when you're sick: you only want certain foods, and most things still you even nauseous, although slightly better than you felt before eating.  

Here are some things I personally found helpful:

- Not getting too hungry.  I ate something every 2-3 hours and often split up my lunch into two separate meals.  I also tried not to eat too much at once, since this made the nausea even worse.  My stash at work:

- Eating protein with breakfast and each snack.  Even though I wasn't quite craving a hard boiled egg or string cheese when my stomach was churning, I felt so much better when I had protein-rich foods. With that being said, I always had saltines from Whole Foods (they don't have partially hydrogenated oils like the name brand ones do) in my desk and purse.

- Ginger, ginger, GINGER!  Candied ginger, ginger chews, and ginger tea were life savers until I realized that I could add some "oomph" with ginger extract supplements.  I took one with each meal after it was cleared by my OB office, and it was an immense help.

- Preggie Pop Drops.  I didn't actually give these a try until I was 10 or 11 weeks along, but their vitamin B6 and essential oil blend really helped.  I bought mine at Buybuy Baby, where I will eventually register.

- Lemons.  I would slice them up and sniff or even suck on them at work.  They really seemed to help cut through the nausea between snacks.  Bonus: when I smelled something strong, such as steamed mussels at a seafood restaurant, I would try to smell the lemon in my water.

- Experimenting with different types of foods.  You'll never know what you will crave, so be open minded to trying new things.  I drank pickle juice (seriously) and craved bagels, eggs, and garbanzo beans.  As long as it's safe for you to eat, just go with it.  The nausea hopefully won't last forever, and it's important to get nutrients into your system.

- ACUPUNCTURE.  By far, more than anything, acupuncture helped me the most.  I didn't figure this out until 9 or 10 weeks, and I was so mad that I waited that long to try it for nausea!  I'm a huge proponent of this ancient Asian healing modality, and it made a world of difference.  I go to Joshuah Kim at Holy Hill Acupuncture.  He was my best friend for weeks.

As much as I wanted to drink green juices and eat as wholesomely as possible for the sake of my baby, I couldn't stomach the thought of certain favorite healthy foods.  My normal rice protein shakes sounded horrible, and some nights all I wanted was Pad Thai from Ling and Louie's.  I still don't like certain foods because they remind me of the time I was so nauseous (white fish and homemade Twix bars come to mind), but I'm eating much more normally and with very few symptoms now.  However, don't freak out if you can only eat toast with butter and scrambled eggs for a few weeks.  It will soon pass, and it's much better than forcing down food that won't stay put.

A word about weight: 

In the first trimester, caloric needs really don't increase, although I found myself eating much more often than normal due to the nausea.  Practitioners recommend gaining 0-5 pounds those first 3 months.  I personally gained about 4 or 5, but I'm not freaking out about my weight.  I normally never weigh myself but did invest in a scale so I can check it out once a week.  I mainly want to make sure I don't have a very sudden weight increase, which could be indicative of preeclampsia.  As of now, I'm tracking at about 1 pound a week weight gain and at this rate will gain approximately 30 pounds.  For those who start with a normal BMI pre-pregnancy, 25-35 is the target range.  However, if I gain more, I'm not going to worry.  I trust my body to tell me what it needs, gain the weight it should, and grow and expand like it will.  It's exciting to know that my body can create life, and that's so much more important than still fitting in my jeans.

About fertility:

 

Every woman's body is very different, and your genetics, physiology, environment, intake, and stress levels all influence your chances of getting pregnant.  We were very fortunate to conceive right away, and I do think that although I have really strong genetics in this area, I also tried to prep my body as best as possible for success.  Here's what I think helps:

- Acupuncture.  Again, it's a godsend.  I did it once a week the month before we started trying and every other week once we did.  It took about 5 weeks to get pregnant, and I contribute this mainly to acupuncture.

- Omega-3s and conjugated linoleic acid.  I took fish oil, ate clean fish and flaxseeds/chia/walnuts/hemp for omega-3s, plus organic pasture butter and grass-fed beef for CLA.  Omega-3s are critical for brain development, and CLAs have been found to help with fertility.

- Maintain an optimal weight.  I purposefully gained a few pounds to ensure regular cycles, since I have a history of being very sensitive to irregularity when my weight is slightly lower.  Once I hit a certain weight (literally 2 or 3 pounds up), I was on a 28-day plan.  If you have problems with your periods, check with your provider to see if you are at the right weight for you.

- Manage stress.  I am the last person to say I'm great at stress management, but I have been very conscientious about sleeping enough, breathing deeply, and laying around doing nothing.  Again, acupuncture really helps with stress too.

If you find that you need help with the first trimester or any point of your pregnancy or pregnancy-planning, let me know.  I love working with women at this stage of their life because they're so excited and motivated to be the best mamas they can, and now I have a few personal tips and tidbits to help them even more!

How did you survive the first trimester?

*M*

Another Reason Why Probiotics Are Important

A lot of people associate probiotics, or good bacteria, with improved digestion and better, er, regularity. Recent research suggests something rather interesting: gut bacteria may be linked to your brain chemistry and behavior. Researchers at McMaster University altered normal gut bacterial content in healthy adult mice using antibiotics, resulting in a change in both behavior and brain-derived neurotrophic factor, an important brain chemical. When antibiotics were stopped and healthy gut flora returned to normal, behavior also normalized.

This research is encouraging, as it further supports how important our gut health is to our overall wellbeing. Furthermore, it promotes further research that might better describe potential links between gut dysfunction and behavior alterations or neurochemical imbalances. Additional study in this area might help us explain links between IBS and depression or ADHD or autism and gut inflammation.

In the interim, it's important to supplement with probiotics, especially after a course of antibiotics. I actually recommend probiotics and fish oil to all of my clients, both adults and children, since omega-3 fast and probiotics are difficult to get in one's diet. My favorite brand is Genestra HMF Forte. I've been using it personally for 3 years upon recommendation by a naturopathic doctor, and I have also had wonderful and professional success with the product. "HMF" stands for Human Micro Flora. According to Genestra, HMF products are cultured from human (instead of cow or pig) gut and have greater adherence to the GI wall. I've recommended it to many clients, and even the ones with the most sensitive stomachs or those who have never had success with probiotics become big fans. You can purchase it through Amazon.com or through me.

Depending on your case and history, I recommend 1-4 capsules per day with food. There are also other HMF products that I like, depending on my client's situation. HMF Replete is a 7-day repletion protocol that is great for use right after a round of antibiotics. Make sure to wait 3-4 days after your last antibiotic dose before starting probiotics.

If you're planning to become pregnant, are prone to colds, have seasonal allergies, or have any gut compromise (like constipation, diarrhea, or GI upset), it's especially important for you to think about probiotics!